Article metrics

  • citations in SCindeks: [1]
  • citations in CrossRef:0
  • citations in Google Scholar:[=>]
  • visits in previous 30 days:1
  • full-text downloads in 30 days:1
article: 7 from 7  
Back back to result list
Medicinski pregled
2004, vol. 57, iss. 9-10, pp. 429-433
article language: Serbian
document type: Original Scientific Paper
published on: 02/06/2007
doi: 10.2298/MPNS0410429S
Elevated aminotransferase levels: Diagnostic approach
Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade

Abstract

Introduction Aminotransferase levels are a sensitive indicator of liver cell injury and is frequently used to identify patients with liver diseases such as hepatitis. Both aminotransferases are normally present in serum at low levels, usually less than 30 U per liter. Although these enzymes are present in tissues throughout the body, they are most often elevated in patients with liver diseases and may reflect liver injury. Raised aminotransferase levels of unknown origin are common problem in clinical practice. Serum alanine aminotransferase (ALT) activity, the variable most commonly measured to assess hepatic disease, fails to identify many patients with hepatic injury. On the other hand, elevated ALT level doesn't always confirm liver disease. The aim of this study was to show the most common reasons for elevated aminotransferase levels. Material and methods The study included 27 patients with elevated ALT. All of them were followed-up for six months before liver biopsy was performed. All patients underwent routine laboratory tests and ultrasound of the abdomen. Results We found that four patients had a nonalcoholic steatohepatitis (NASH), four patients had chronic hepatitis of unknown etiology, two of them had autoimmune hepatitis, four had mild lobular hepatitis (three of them unresolved acute hepatitis, one of them had nodular regenerative hyperplasia), six patients had normal results, and three had no specific changes. Conclusion Elevated ALT level doesn't always mean that there is a liver disease. If aminotransferase levels are persistently more than twice the normal value, a biopsy is recommended. Although results of biopsy are unlikely to lead to a diagnosis or to changes in management, they often provide reassurance to the patient and the physician to exclude serious pathology.

Keywords

References

Alter, M.J., Kruszon-Moran, D., Nainan, O.V., McQuillan, G.M., Gao, F., Moyer, L.A., Kaslow, R.A., Margolis, H.S. (1999) The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med, 341(8): 556-62
Berasain, C., Betes, M., Panizo, A., Ruiz, J., Herrero, J.I., Civeira, M.P., Prieto, J. (2000) Pathological and virological findings in patients with persistent hypertransaminasaemia of unknown aetiology. Gut, 47(3): 429-35
Cleavinger, P.J., Persing, D.H., Li, H., Moore, S.B., Charlton, M.R., Sievers, C., Therneau, T.M., Zein, N.N. (2000) Prevalence of TT virus infection in blood donors with elevated ALT in the absence of known hepatitis markers. Am J Gastroenterol, 95(3): 772-6
Craxi, A., Almasio, P. (1996) Diagnostic approach to liver enzyme elevation. J Hepatol, 25 Suppl 1: 47-51
Czaja, A.J. (1984) Natural history, clinical features, and treatment of autoimmune hepatitis. Semin Liver Dis, 4(1): 1-12
Das, A., Post, A.B. (1998) Sholud liver biopsy be done in asymptomatic patients with chronically elevated transaminases: A cost-utility analysis. Gastroenterology, 114:A9. abstract
Manns, M.P. (1999) Autoimmune hepatitis. in: Schiff E.R., Sorrell M.F., Madrey W.C. [ed.] Schiff's diseases of the liver, New York-Philadelphia, itd: Lippincott, vol. 2.str. 919-35
Piton, A., Poynard, T., Imbert-Bismut, F., Khalil, L., Delattre, J., Pelissier, E., Sansonetti, N., Opolon, P. (1998) Factors associated with serum alanine transaminase activity in healthy subjects: Consequences for the definition of normal values, for selection of blood donors, and for patients with chronic hepatitis C. MULTIVIRC Group. Hepatology, 27(5): 1213-9
Prati, D., Taioli, E., Zanella, A., della Torre, E., Butelli, S., del Vecchio, E., Vianello, L., Zanuso, F., Mozzi, F., Milani, S., Conte, D., Colombo, M., Sirchia, G. (2002) Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med, 137(1): 1-10
Pratt, D.S., Kaplan, M.M. (2000) Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med, 342(17): 1266-71
Pratt, D.S., Kaplan, M.M. (1999) Laboratory tests. in: Schiff E.R., Sorrell M.F., Maddrey W.C. [ed.] Schiff's diseases of the liver, New York-Philadelphia, itd: Lippincott, vol. 1.str. 205-44
Schiff, E.R., de Medina, M., Kahn, R.S. (1999) New perspectives in the diagnosis of hepatitis C. Semin Liver Dis, 19 Suppl 1: 3-15
Sorbi, D., mc Gill, D.B., Thistle, J.L., Henry, J.J., Therneau, T.M., Lindor, K.D. (1999) An assessment of the role of the liver biopsies in asymptomatic patients with chronic liver test abnormalities. Hepatology, 30:(Suppl):477A. abstract
Strauss, R.S., Barlow, S.E., Dietz, W.H. (2000) Prevalence of abnormal serum aminotransferase values in overweight and obese adolescents. J Pediatr, 136(6): 727-33
Wejstal, R., Hansson, G., Lindholm, A., Norkrans, G. (1988) Persistent alanine aminotransferase elevation in healthy Swedish blood donors: Mainly caused by obesity. Vox Sang, 55(3): 152-6
Yarze, J.C. (1996) Autoimmune hepatitis. N Engl J Med, 334(14): 923-4